Three-Day Phenytoin Prophylaxis Is Adequate After Subarachnoid Hemorrhage

Chumnanvej, Sorayouth; Dunn, Ian F.; Kim, Dong H.

doi:10.1227/01.neu.0000249207.66225.d9

Cited by 65 publications

(44 citation statements)

References 25 publications

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“…In other series, effect of AEDs medication on prevention of late epilepsy was unclear 17,23,24) . These data were similar to those noted for patients with traumatic closed head injury in whom early AED use did not change the incidence of delayed epilepsy 6,10,28,31) .…”

Section: General Overviewsupporting

confidence: 83%

Seizures and Epilepsy following Aneurysmal Subarachnoid Hemorrhage : Incidence and Risk Factors

Choi

et al. 2009

J Korean Neurosurg Soc

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Objective : Although prophylactic antiepileptic drug (AED) use in patients with aneurysmal subarachnoid hemorrhage (SAH) is a common practice, lack of uniform definitions and guidelines for seizures and AEDs rendered this prescription more habitual instead of evidence-based manner. We herein evaluated the incidence and predictive factors of seizure and complications about AED use. Methods : From July 1999 to June 2007, data of a total of 547 patients with aneurysmal SAH who underwent operative treatments were reviewed. For these, the incidence and risk factors of seizures and epilepsy were assessed, in addition to complications of AEDs. Results : Eighty-three patients (15.2%) had at least one seizure following SAH. Forty-three patients (7.9%) had onset seizures, 34 (6.2%) had perioperative seizures, and 17 (3.1%) had late epilepsy. Younger age (< 40 years), poor clinical grade, thick hemorrhage, acute hydrocephalus, and rebleeding were related to the occurrence of onset seizures. Cortical infarction and thick hemorrhage were independent risk factors for the occurrence of late epilepsy. Onset seizures were not predictive of late epilepsy. Moreover, adverse drug effects were identified in 128 patients (23.4%) with AEDs. Conclusion : Perioperative seizures are not significant predictors for late epilepsy. Instead, initial amount of SAH and surgery-induced cortical damage should be seriously considered as risk factors for late epilepsy. Because AEDs can not prevent early postoperative seizures (< 1 week) and potentially cause unexpected side effects, long-term use should be readjusted in high-risk patients.

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Section: General Overviewsupporting

confidence: 83%

Seizures and Epilepsy following Aneurysmal Subarachnoid Hemorrhage : Incidence and Risk Factors

Choi

et al. 2009

J Korean Neurosurg Soc

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“…Table 3 These data suggest that the effect of prophylactic PHT may be analogous to subarachnoid hemorrhage in terms of increased fever and worse functional outcomes. 9,10 More patients received prophylactic PHT than had seizures clinically or on EEG monitoring, suggesting that clinicians were more concerned with seizures than potential toxicity from PHT.…”

Section: Discussionmentioning

confidence: 99%

“…8 Increased PHT exposure, however, is associated with worse cognitive and functional outcomes after subarachnoid hemorrhage 9 with fewer side effects after 3 compared with 14 days of prophylaxis. 10 Preventing seizures after ICH may not improve outcomes because seizures may not be independently associated with worse outcomes after adjustment for other predictors. 4,11 Additionally, AED use (especially PHT) might be associated with fever, and fever is associated with worse outcomes after ICH.…”

mentioning

confidence: 99%

Anticonvulsant Use and Outcomes After Intracerebral Hemorrhage

Naidech

Garg

Liebling

et al. 2009

Stroke

189

123

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Background and Purpose-There are few data on the effectiveness and side effects of antiepileptic drug therapy after intracerebral hemorrhage. We tested the hypothesis that antiepileptic drug use is associated with more complications and worse outcome after intracerebral hemorrhage. Methods-We prospectively enrolled 98 patients with intracerebral hemorrhage and recorded antiepileptic drug use as either prophylactic or therapeutic along with clinical characteristics. Antiepileptic drug administration and free phenytoin serum levels were retrieved from the electronic medical records. Patients with depressed mental status underwent continuous electroencephalographic monitoring. Outcomes were measured with the National Institutes of Health Stroke Scale and modified Rankin Scale at 14 days or discharge and the modified Rankin Scale at 28 days and 3 months. We constructed logistic regression models for poor outcome at 3 months with a forward conditional model. Results-Seven

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“…After this initial period the incidence of seizures is low [18]. Chumnavej et al demonstrated that a 3-day regimen of phenytoin prophylaxis is safer and equally effective in comparison with arbitrary longer-term phenytoin coverage, as the incidence of significant side effects is greatly reduced without a concomitant increase in the risk of seizures, even if 80% of patients received aneurysm repair by craniotomy [22]. This data is consistent with that of traumatic head injury patients in whom early anticonvulsant use did not change the incidence of late seizures.…”

Section: Anticonvulsants For Subarachnoid Hemorrhagesmentioning

confidence: 99%

Prophylactic antibiotics and anticonvulsants in neurosurgery

Ratilal

Sampaio

2011

Advances and Technical Standards in Neurosurgery

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The prophylactic administration of antibiotics to prevent infection and the prophylactic administration of anticonvulsants to prevent first seizure episodes are common practice in neurosurgery. If prophylactic medication therapy is not indicated, the patient not only incurs the discomfort and the inconvenience resulting from drug treatment but is also unnecessarily exposed to adverse drug reactions, and incurs extra costs. The main situations in which prophylactic anticonvulsants and antibiotics are used are described and those situations we found controversial in the literature and lack further investigation are identified: anticonvulsants for preventing seizures in patients with chronic subdural hematomas, antiepileptic drugs for preventing seizures in those suffering from brain tumors, antibiotic prophylaxis for preventing meningitis in patients with basilar skull fractures, and antibiotic prophylaxis for the surgical introduction of intracranial ventricular shunts.In the following we present systematic reviews of the literature in accordance with the standard protocol of The Cochrane Collaboration to evaluate the effectiveness of the use of these prophylactic medications in the situations mentioned. Our goal was to efficiently integrate valid information and provide a basis for rational decision-making.

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Three-Day Phenytoin Prophylaxis Is Adequate After Subarachnoid Hemorrhage

Abstract: A 3-day regimen of PHT prophylaxis is adequate to prevent seizures in subarachnoid hemorrhage patients. Drug reactions are significantly reduced, but seizure rates do not change. Short-term PHT administration may be a superior treatment paradigm.

Cited by 65 publications

References 25 publications

Seizures and Epilepsy following Aneurysmal Subarachnoid Hemorrhage : Incidence and Risk Factors

Seizures and Epilepsy following Aneurysmal Subarachnoid Hemorrhage : Incidence and Risk Factors

Anticonvulsant Use and Outcomes After Intracerebral Hemorrhage

Prophylactic antibiotics and anticonvulsants in neurosurgery

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